Patients cared for by doctors called "hospitalists," who work full-time in hospitals to focus on general patient care, fare slightly better than those cared for by general internists or family doctors, finds a new study.
Hospitalists reduce a patient's average hospital stay by 12 per cent, and modestly lower treatment costs, the study found. But they do not help lower patients' death risk or the chance that they will have to be readmitted.
Hospitalists are doctors who work full-time at hospitals, performing generalist duties traditionally handled by family doctors or internists making rounds.
Though hospitals in Canada are just beginning to make use of hospitalists, many hospitals in the U.S. have well-established hospitalist programs. In fact, the category has been one of the fastest-growing medical specialties of the past decade in the U.S., according to the Society of Hospital Medicine.
Researchers from Tufts University School of Medicine decided to take the first wide-scale look at hospitalists, to see whether their use saves hospitals time and money.
They followed 75,000 patients admitted to 45 U.S. hospitals between September 2002 and June 2005 for such common conditions as pneumonia, stroke, chest pain, heart attack or heart failure, and urinary tract infection.
As compared with patients cared for by general internists, those under the watch of hospitalists had a slightly shorter hospital stay -- about half a day off the average of four days.
That's a small but significant improvement, says lead study author Dr. Peter Lindenauer, associate professor of medicine at Tufts School of Medicine.
"Even though the differences in the length of stay may seem small, when multiplied by the thousands of admissions that hospitalists see each year, the effects can be quite large," Lindenauer said.
"A 0.4 day shorter length-of-stay per case multiplied by 5,000 cases annually will save 2,000 bed days and enable 500 more patients to be cared for each year without increasing the number of hospital beds. Moreover, there aren't many interventions capable of achieving these kinds of efficiency gains," he added.
To the surprise of the researchers though, death rates were similar whether a patient was cared for a hospitalist or not, the study also found. The likelihoods that a patient would need to be readmitted within two weeks (which is usually a sign that a patient had been sent home too early) were also similar.
Hospitalists saved hospitals an average of US$268 per patient, a saving not considered significant.
The results are published in the
Some believe that hospitalists improve care, because a patient is looked after by a single doctor who spends his or her entire day in the hospital and is able to make treatment decisions as they come up, unlike doctors who only make decisions on a patient's care when they stop in for rounds.
Yet others say hospitalists are less efficient than a family doctor who makes rounds at a hospital because a hospitalist doesn't know a patient's full medical history and may therefore order more tests.
"The lack of clear cost savings, despite more than a 10 per cent reduction in the length of stay, suggests that... hospitalists compress the same or even greater amounts of testing and treatment into a shorter amount of time," the study authors suggest.
Dr. Khalil Sivjee, the education director of the Hospitalist Training Program at Sunnybrook Health Sciences Centre in Toronto says there is a growing place for hospitalists in Canada, particularly since so many Canadians lack a family doctor.
"In fact, the last estimates were about 5 million Canadians don't have a family doctor. So what happens to those patients when they get admitted to hospitals? Somebody has to be responsible for their care, and hospitalists have been the answer to that question," he told Â鶹´«Ã½.
He notes there are also fewer general internists in Canada, who traditionally cared for patients in hospital. "Many are retiring, many are at retirement age and fewer residents are choosing general internal medicine as a career path," he says.
Many medical students who have trained in family, internal or emergency medicine are now taking his one-year fellowship in Hospital Medicine, and are helping to fill the gap left by retiring internists.
"There is a possible solution to it, and that solution is having family medicine doctors who prefer to work in the hospital, or to have a predominant part of their practice in the hospital, become hospitalists," he says.
"Being a hospitalist is actually a popular choice for some family medicine graduate trainees," he says. "Personally, I found it very gratifying working in a hospital."
"I think that the movement is here to stay, and as the population becomes older, sicker, more complex, there are going to be more needs for hospitalists."
With a report by CTV medical specialist Avis Favaro and producer Elizabeth St. Philip
